Intended for healthcare professionals


Multidrug resistance responsible for half of deaths from healthcare associated infections in Europe

BMJ 2008; 336 doi: (Published 05 June 2008) Cite this as: BMJ 2008;336:1266
  1. Rory Watson
  1. 1Brussels

Multidrug resistant bacteria are responsible for about half of the 37 000 deaths a year in the 27 member states of the European Union that are caused by infections associated with health care, show the preliminary results of research from the European Centre for Disease Prevention and Control, in Stockholm.

The official findings, which will be presented later this summer, coincide with growing political and medical pressure for a reduction in the use of antibiotics in a bid to curb increases in drug resistant bacteria.

Dominique Monnet, the centre’s senior expert in its scientific advice unit, who presented the initial conclusions of the study at a seminar for journalists last week, insisted that the detrimental effects of antibiotics could even be greater.

“This is an underestimate since we are considering only the seven most common multidrug resistant bacteria and the four main types of healthcare associated infections—bloodstream infection, pneumonia, skin and soft tissue infection, and urinary tract infection,” he said.

To counter this trend he maintained it was necessary to focus not on the bacteria but on two processes. Firstly, he called for prudent use of antimicrobials, prescribing them only when needed and in correct doses and for the recommended duration. Secondly, he emphasised the need for infection control through personal hygiene and screening and isolation of patients where necessary.

Herman Goossens, professor in medical microbiology at the University of Antwerp and coordinator of the European Surveillance on Antibiotic Consumption, explained how Belgium, previously a high user of antibiotics, was beginning to reverse the trend.

Through high profile media campaigns that began in 2000, aimed at the public and the medical profession, the authorities succeeded in reducing outpatient antibiotic use between 1999 and 2006 by 32%. At the same time, antibiotic resistance of Streptococcus pneumoniae in Belgium, which had climbed steadily since the mid-1980s, had begun to tail off in the past three years.

The European Union has already considered the overprescription of antibiotics. In 2001 EU governments agreed a set of non-binding guidelines on “the prudent use of antimicrobial agents in human medicine.” To reinforce the message Slovenia, which currently holds the rotating EU presidency, is urging health ministers to update, endorse, and implement the advice when they meet in Luxembourg on 9 June.

This will be reinforced by a campaign organised by the European Centre for Disease Prevention and Control in the autumn to inform the general public when and how to take antibiotics. This will culminate in a European antibiotic awareness day on 18 November.


  • Competing interests: RW’s travel and accommodation costs for the Stockholm seminar were paid for by the European Centre for Disease Prevention and Control.

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